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“Learning disability services must be reshaped and localised”


We must ensure the wrongs of Winterbourne View are righted, says Jim Blair

”Enough is enough” – that is what is stated in Mencap’s and the Challenging Behaviour Foundation’s recent
Out of Sight report in relation to the systematic abuse meted out by staff to people with learning disabilities at Winterbourne View.

Winterbourne View was a large, closed private hospital purporting to provide assessment and treatment to people with learning disabilities. In reality, as revealed by secret filming by the BBC’s Panorama programme last year, torture rather than treatment was provided. There is a place for assessment and treatment services, but the settings in which these are provided should not be large and should be focused on providing targeted outcome-oriented, person-centred care.

The fact that many of Winterbourne View’s residents were living far away from their family and friends meant that they became increasing isolated.

“Just as a sea change in care provision took place with the closure of long-stay “asylum” hospitals, the time is now up for their modern-day incarnations like Winterbourne View”

Those authorities purchasing the care provided by Winterbourne View did not robustly monitor what kind of assessment and treatment was being provided. Such a closed environment provides conditions where abusive behaviour can thrive and this happened at Winterbourne View. Since the exposure of the abuse in that private hospital, the Care Quality Commission inspected all similar services for people with learning disabilities. They found that 50% of the hospitals and care homes inspected failed to meet care and welfare standards as well as those standards related to protecting people from abuse. While there are services that provide good care, there is still much to do to ensure all services provide appropriate safe care.

The money commissioners spend on placing people away from family and friends should be redirected to enhance and commission new services locally. Reshaping and localising services is achievable and can be delivered if creative, innovative practices are adopted. Such services need to be planned, developed and delivered in partnership with people with learning disabilities, families, carers and professionals. Robust regulatory and monitoring systems need to be effectively used to stop vulnerable people being exposed to abuse. A national group should be set up, which is made up of people with learning disabilities and family carers, regulatory bodies, social and health professionals to champion care. This group should have the authority to steer services and enforce change.

Just as a sea change in care provision took place with the closure of long-stay “asylum” hospitals, the time is now up for their modern-day incarnations like Winterbourne View.

In a country that seeks to cast itself as a paragon of human rights, we must ensure that the wrongs of Winterbourne View are righted by the creation of appropriately planned, styled and delivered person-centred services close to a person’s family and other networks. All staff working with people with learning disabilities must be educated in how to practice in a safe person-centred manner.

The government needs to strengthen the law on adult safeguarding to ensure people’s safety. Rigorous action must be taken against individuals and organisations when abuse occurs.

We have an opportunity to get it right. It is essential to grasp it and move forward with everyone working together to ensure that people who are vulnerable are no longer out of sight, but are clearly within all of our visions for a better, fairer and more just society.

Jim Blair is consultant nurse intellectual (learning) disabilities, St George’s Healthcare Trust and senior lecturer intellectual (learning) disabilities Kingston University and St George’s University of London


Readers' comments (4)

  • A Nonny Mouse

    People with learning disabilities deserve the best possible care from staff, whether it's in a residential home or in the community.

    This is an area of nursing that gets forgotton, overlooked and no-one really talks about.

    It is a speciality, it used to be a separate nurse training course of its own, but now of course it's not.

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  • Ref the headline

    doesn't this apply to the majority of services in the NHS and community?

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  • re: A Nonny Mouse

    Learning Disabilities Nursing is still a separate branch of nursing, it has its own training programme that are running at universities.

    I myself qualified in 2010 as a Registered Learning Disabilities Nurse (RNLD) and currently work in the NHS.

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  • Private or NHS, there are some amazing services that provide truly person centred care, where people are treated with dignity and respect, however there are also some places that we hear about that provide appauling care, we must ensure that the bad are closed down, people taken to court and fined or imprisoned for abusing the most vulnerable people in society.

    Services must provide clinical leadership at all levels, with the right checks in place to support staff when working with people who are vulnerable ie supervision, audits of practice, clinical reviews with families or carers. Staff also need access to ongoing education and training, so people are able to think about what they are seeing and challenge, winterbourne was known about for some time, do leaders not know the reality of care within their services, if you don't you need to get out of your office, if you do, do something, doing nothing is not an option

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